Breathing space

Healthy living centres are filling gaps in mainstream services
by providing disadvantaged young people with an opportunity to
assess their health, lifestyles, and well being. But are they here
to stay, asks Alex Klaushofer.

On the face of it, healthy living centres offer an ideal way of
meeting the health needs of socially excluded young people.
Flexible enough to respond to local needs, targeted at the most
disadvantaged and using a definition of health which encompasses
social, educational and economic issues, the healthy living centre
programme sounds the perfect way to improve young people’s
health and well being.

The programme was launched in 1999 with £300m in lottery
funding from the New Opportunities Fund and is a key plank in the
government’s strategy to improve public health. The idea is
to complement NHS provision, and much of the emphasis is on health
education. Schemes to encourage people to exercise, to stop smoking
and to develop healthy eating habits are core features, and
alternative therapies are often on offer as well. The centres vary
from area to area, and are generally run by partnerships of public
sector providers and voluntary sector organisations. About
£267m of the programme funding has now been allocated, and 349
centres set up around the UK.

Young people are the focus of many of the projects. The
Underground is a drop-in centre in Edinburgh for socially excluded
16 to 25 year olds run by a partnership of seven agencies. As well
as access to core health services through visits from a dentist,
nurse and optician, it offers group discussions on sexual health
issues and parenting skills. But, according to youth services
manager Ali Grant, the centre also meets a more basic need.
“There’s a whole group who come in simply to have a safe
space,” she says. “For example, someone on medication may turn up
and say ‘I just want to be somewhere for an hour’.
Others come in a state of crisis, and say ‘I need to see
someone now’.”

Grant estimates that the centre, which opened in November 2001
with £478,000 in NOF funding, now welcomes up to 50 young
people a week. “There’s obviously a need for it,” she says.
“We’ve managed to tap into a group that many other people
have found difficult to engage with.” But she adds that getting
results can be a slow process. “It can take a year or more to build
up the relationships with the young people we’re
targeting.”

One of the new healthy living centres, the Dales HLC Choice
Programme has begun setting up a range of projects to combat rural
isolation. With almost £2m, it has one of the largest grants
awarded to a HLC, and is due to be launched formally by late
summer. Although the HLC has an obligation to meet some of the
local population’s clinical needs, “above that, young people
are our number one priority”, says Philip Gover, joint planning
manager of Durham Dales Primary Care Trust, the project’s
lead agency. In contrast with the Underground in Edinburgh,
Dales’ work will not revolve around a centre. “It’s a
network of different activities; there’s no bricks and
mortar,” he says.

Projects include a community dietician, community transport, a
scheme to support the use of allotments and various health
education programmes. One scheme aims to meet some of the emotional
and practical needs of young people looking after disabled
relatives. “Young carers are forgotten. Unless you can pick up on
them early, they suffer as a result of their caring
responsibilities,” says manager of the Young Carers Project Judith
Tuck.

However, there is a danger that much of this new work may fall
by the wayside once the one-off lottery funding for the programme
comes to an end. Once their funding terms of three to five years
expire, all healthy living centres face the challenge of finding
replacement funding if they are to continue. “There are very few
options unless one of the statutory services takes us on,” says
Grant. “Beyond that, we’re dependent on trust funds and these
are also time-limited.”

The New Opportunities Fund does not have any ready solutions.
“Sustainability is always an issue,” says NOF chairperson Baroness
Jill Pitkeathley. But she hopes that, as the healthy living centres
prove themselves, more support will be forthcoming. “There is a
huge amount of commitment from government, and it’s for us to
make the case for how successful the programme has become.”

Gover is looking for a solution in a related challenge facing
the healthy living centre programme: how to integrate new,
successful projects into mainstream services. “We’ll monitor
these projects to demonstrate their worth and look to mainstream
them in partnership with our mainstream providers,” he says. The
Dales HLC is already envisaging a new, collaborative approach,
whereby different agencies such as district councils and primary
care trusts come together to share the funding burden for
particular projects.

But Gover acknowledges that ensuring the survival of healthy
living centres in this way may impact on other services. “We
can’t continuously develop. There may have to be a lack of
investment in other areas.”

‘Young people can use our services without
stigma’

The Building Bridges HLC based in Boothferry, Yorkshire, which
opened in April 2002, is devoting two of its six community-based
projects to young people. The Hinge daycentre, which receives
£200,000 of the £1m awarded to the healthy living centre
overall, provides housing and training advice for young people at
risk of homelessness. A rural youth initiative aimed at 11 to 24
year olds, brings together a young people’s forum and a
project worker to devise anti-drugs and leisure activities.

Sheila Howard, the project co-ordinator for Boothferry Council
for Voluntary Service, the HLC’s lead agency, says that the
schemes are already filling a gap in mainstream service provision.
“A lot of young people will not go to the statutory services. They
will potentially be living rough on the streets,” she says. “The
key difference is that young people see us as supportive of their
needs and they can access the services without stigma.”

The emphasis of the project, Howard says, is to address the
problems characteristic of life for young people in the area: high
levels of family breakdown, combined with poor levels of
educational achievement. “We’re trying to help young people
focus on some sort of future, rather than a day-to-day existence,”
she says. “It’s about making that transition to some sort of
independence.”

The project’s rural youth worker, Nigel Howard, does
street work with the young people of Gollos and its outlying
villages. He says the problems are typical of those faced by young
people in the countryside. “It’s boredom. There’s no
transport, so you find big groups of young people hanging about,”
he says. He estimates that over the past year he’s worked
with more than 500 young people, and says the key to success is
letting them take the lead. “It’s meeting them in their
place, and finding out what they want to do,” he says.

Is there a danger that the work of the HLC will go by the board
when the funding expires in five years’ time? “Definitely,”
says Howard. But, he adds: “All the healthy living centres are
funded for three to five years, which gives more time for
sustainability.”